This post is both an observation and a related query. I want to know if what I’m seeing is particular to my area, or if it’s happening all over the place.
As one might imagine, I see patients for all manner of medical complaint. Some of them are complicated and severe, and some are minor and self-limiting. Because common things are common (a medical truism, of which we are reminded in our training when we go off investigating bizarre and rare diagnoses), I see many more patients for the latter kind of problem than the former. Strictly speaking, a lot of people come in to see me for things that probably could have been monitored at home without medical attention. Mind you, I am not complaining about that fact, as these sorts of “bread and butter” visits are what keep a medical office’s doors open.
A large factor in parents’ decisions to bring their kids in for a visit is their own caution or anxiety. Educating parents about major vs. minor symptoms, what can be treated at home vs. what needs to be seen, etc is an important part of my job, as is allaying anxiety to whatever extent possible. Taking care of parents is as much (or more) a part of my job as taking care of the kids, which I think almost any honest pediatrician would say. If I didn’t like dealing with worried parents, I shouldn’t have entered the field.
That said, I have had a truly stupefying number of appointments that the parents themselves view as totally unnecessary. They don’t think their kid needs to be seen, and they know I don’t think so either. They’re missing work they don’t think they need to miss, and are languishing in my office for reasons they consider ridiculous.
Why are they there? Because their kid’s school demands a doctor’s note. Any absence attributed to illness must be verified by me, with a note documenting same. Otherwise it is unexcused, for which the student is penalized. It matters not if the illness is as minor as a cold, or if the student has an otherwise spotless attendance record. It makes no difference if the child was sent home by the school nurse (in which case a note stipulating that the child is well enough to return is required) or kept home at the parent’s discretion. Every absence requires a note, which requires a visit.
This is, of course, totally idiotic. I am providing a service when I see ill children, even if the illness is mild and the service is really for the worried parents. Those visits have value, even if they’re not “necessary.” A visit for the sole purpose of verifying the parent’s claim of sickness is a complete policy fail. It robs parents of their authority and subjugates them to the dictates of the educational bureaucracy. It contributes needlessly to medical costs and wastes everyone’s time. (Were I in cahoots with the local school nurses, I could not design a better kick-back scheme if I tried.)
When did this happen? I seem to recall that my mother’s say-so was enough to keep me home from school for a few days. I think a doctor’s note was required for lengthier absences, but for a day or so all that was necessary was for her to tell the school I was sick. When did this change?
An addition wrinkle to my observation is that it is not consistent with all parents/patients. My office is situated in an area with great socioeconomic diversity. Many of my patients attend the local exclusive and famous (you’ve heard of it) private school or the affluent public school nearby. Many of my other patients live in the much poorer surrounding areas, and attend the much less well-off schools. Whenever I offer a note to the wealthier parents, they wave it away. Apparently their word is still good. It is students who attend the less cushy schools who need the notes from me, and it is their parents whose authority has been usurped. If my observation is a true reflection of reality, then it reflects something disgraceful.
So, here comes the query — is this true where you live? If you have kids, can you keep them out of school for a day or two due to illness without needing to schlep them to the doctor? Or must you also procure a perfectly useless note from a medical provider? If so, how do you feel about this policy?
When I was a kid, my mom occasionally had us take a day off of school to go to a museum and out to lunch. She called the school and said “Jay and Jay’s sister won’t be in on Friday. We’re going to a museum.”
We went to a museum.
That was that.
From what I understand now, however, there is funding associated with whether there is an ass in a seat on any given day… which creates a perverse incentive. Some anecdata: My sister is, as I’ve said, an elementary school teacher and she’s told me stories about “count day” (I think it was called)… If the kid has CHICKEN POX, they want the kid brought into the school just long enough for one of the pencil pushers can put a check in a box before the kid is taken back home.
For what that’s worth.
I think Jay’s exactly right. This is about schools being funded based on attendance, so you’ll never see it from a private school parent.
It’s not just the kids in private schools. The ones whose kids go to the public school in the affluent communities don’t seem to need notes, either.
I’d guess that the more affluent schools have greater funding and both better and more reliable attendance, so they’re not as anal about notes.
Of course, they also have parents less likely to be docked if they miss a few hours of work, but no one ever said life was fair.
I also suspect that more affluent parents are more aware and protective of their prerogatives, and more likely to protest effectively if said prerogatives were eroded.
Russ-
There is a bit of chicken-and-egg to that. Some parents have their protests heard. Others are ignored or told that there is no room for protest. This divide often falls along the same lines.
I think Chicago Public Schools have “count day,” too. But if someone knows better, they can tell me if I’m wrong. I don’t remember if Denver Public Schools did.
In my district in Michigan all it takes is a call – we do have to give symptoms of the illness and if it is over three days, we need to get a Doctor’s note. Kids can be excuse for vacation as well so if I called and said I was taking the girls to the museum, it is considered also an excused absence. Having worked in the District office, I can confirm that enforcing stricter attendance policies is definitely at least partially tied to the per-student funding model.
“When did this change?”
I’ll go out on a limb and guess “when funding for schools became tied not only to enrollment, but attendance”.
Here’s an idiocy for you. We’re taking our kids out of school for a week at the end of the year, because Kitty is taking them to Washington D.C. Since they’re out for a week (5 days), the teacher can give them an individual learning plan for the 5 days and they can stay current on their lessons and they count as both enrolled and attending.
But if they were out for four days, for (say) an illness, even if Kitty showed up every morning and got the day’s assignments and had the kids keep up with their work, they count as enrolled but not attending, and the school does not get paid their headcount for those students for the four days.
This is so mindbogglingly stupid it makes me want to challenge almost everyone who mentions “school accountability to the taxpayer!” to a boxing match.
Seriously?!?! I had no idea! That’s absolutely horrifying!
“Many of my patients attend the local exclusive and famous (you’ve heard of it) private school or the affluent public school nearby. Many of my other patients live in the much poorer surrounding areas, and attend the much less well-off schools. Whenever I offer a note to the wealthier parents, they wave it away. Apparently their word is still good. It is students who attend the less cushy schools who need the notes from me, and it is their parents whose authority has been usurped.”
As a teacher, I can say that this extends well beyond just the notes. When the poor kid shows up to school without his coat, people want to call CPS. When the rich kid does, everyone just laughs at what they presume is another “Free Range Child” advocate. The whole situation would be funny if it weren’t for that whole SOMETIMESTHEYACTUALLYDOCALLCPS!!!!!!!!!!!!! thing.
Of course, I should restrain my outrage. If the poor parents knew how to parent, they’d be smart enough to not be poor. Duh.
When I see a kid without his coat, I picture the conversation that went:
“Don’t forget your coat. It’s cold out there.”
“OK, Mom.”
“It’s hanging in the closet at the bottom of the stairs.”
“Yes, Mom.”
“I don’t want you catching cold.”
“Sure, Mom. Bye.” (Child leaves without coat.)
So many memories.
That pretty much describes most of the times I went coatless as a child. Ironically (or not), I now usually carry at least a jacket with me, even on warm days, because I get cold very easily now and (you never know) the weather might change.
It also changed when education stopped being a privilege and started being a right.
And it’s important that you exercise your rights properly, citizen.
Up until a few years ago, I opposed compulsory schooling (I’m still not sold on it, but presently consider it to be the lesser of evils until I am made King). So of course this kind of thing just drives me crazy. I mean, if we’re going to have compulsory attendance, I can understand a procedure by which you investigate kids that are missing a lot of school. But at the least they should have a buffer. If they miss no more than five days (or 10 or whatever) due to sickness, they shouldn’t need a note.
Back when my brother was in school, our basketball team made the state finals. They had an announcement over the intercom that say “If you think you might be sick on Friday (the night the tournament started), please try to be here at 10:30 (the official funding roll call) before you get sick.”
Kind of makes one yearn for the good old days of the truant officer–I guess.
I have to wonder why there isn’t more of a public outcry against this sort of thing.
I have never even heard of this practice. In fact, one of the things that we used to get at the start of every school year during the Elementary years was a reminder notice that when our kids had cold, had thrown up within 24 hours, etc., we were supposed to keep them home. I remember this sometimes causing child are headaches.
(BTW, I suspect that, ironically, if you had posted this story instead of yours Duck would have had the same response.)
I am in residency in FP in a Southern City. My schedule is filled daily with students coming just for excuses. But, as much as I hate to say it, I understand why schools have cracked down. I have parents whose kids were sick Thursday, better Friday, but they kept them out anyway, then show to my clinic Monday and want an excuse for all 3 days! This is insane to me, as someone who values education, and I’m glad our clinic has a policy for excuse only for the day you’re seen, unless it’s an obvious exception. I asked one mom why she didn’t come to clinic on Friday in this scenario, and she said it was because they all slept in til noon, and missed our clinic hours and the cutoff for school. I think that there are a group of parents who are abusing the system and ruining it for everyone else. I can usually spot these parents from a mile away, and it saddens me that they enable their children to skip multiple days from school for things like constipation, but then won’t give them any medicine I offer for it…
And I experience it, too. My 4 month old son got a viral URI, with a mild fever. He was quarantined from daycare, saying they would not accept him back until we had a doctor’s note and either:
1. documented 24 hours fever free, OR
2. Antibiotics to send with him
So I’m being forced to give antibiotics if I need to work? My doctor-head that knows how many viruses spread in daycares (and has been beaten with warnings of antibiotic resistance!) was ready to explode!
My new favorite and growing trend is this: Parent brings Child A to clinic because they are sick, request treatment and school excuse for child and work excuse for parent. Ok, I’m on board. But then, parent also keeps out of school Children B and C, and wants excuses for them. Also, Parent’s Friend X comes to the appointment with their child and wants an excuse for both. I guess we’re working with, “It takes a village?” It’s really only difficult to manage because I have to contain my laughter.
I’m glad our clinic has a policy for excuse only for the day you’re seen, unless it’s an obvious exception
We have that policy, too. In addition, parents that ask for a multiple-day excuse are treated to a boring wheeze from me about how a note from me is my professional word, and I can’t really give my word about things I didn’t see, now can I?
This is the case here too, my son’s school also require a Doctor’s note (which at our surgery comes with a £20 admin fee). My son suffers from frequent sore throats, it seems with every cold that goes round, still his attendance is not below the percentage they set for “persistent absence”. The Doctor tested him for strep and glandular fever previously to no avail and it was during that illness that most of his absence accumulated.
The problem is that I can not afford the admin fee for notes that the school require – they will not accept an appointment card, copies of prescriptions and have refused to phone the doctors (with my permission) to confirm his attendance with the receptionist. In fact they have gone so far as to say that if the sore throats are recurrent then nothing less than a letter from a Registrar will suffice. It beggars belief that I have had to inform them that it is not in my power to refer him to one.
He was off school for three days in May with a leg sprain – obviously it would have been a waste of the Doctor’s time to take him with that ailment as I could easily manage it at home – not to mention self-defeating with the walk involved to get there. Anyhow, as it was May and even though it was after his exams, the school would not authorise it without a medical note which I could not produce as it had not been necessary to go there, so I was fined for truancy. Obviously I complained bitterly about this and was told that the school have a “support system for pupils who are ill including the provision of a school nurse on a Monday”.
Today he is ill again with a sore throat (he had a minor cold until he did cross country at school yesterday). I have emailed the school attendance officer saying that he is attending whilst ill and given that they have effectively removed my right as a parent to seek medical attention by imposing these fines and insisting on medical notes, that he needs to see the school nurse today (Thursday), only she will not be present till Monday. I have also told them that if this is supposed to be sufficient medical provision for supporting their pupils, then she should be there every day and that I assume that she is also able to prescribe! I could not agree more with your comment about a better kickback for the school nurse. Also informed them that their actions are hardly congruent with the principle of their being legally bound to act en loco parentis as they are effectively denying him medical treatment in insisting on notes whilst in the full knowledge that they are unaffordable. In fact, my boy is now attending school in sewn up uniform from last year because of their fine, which I am sure will do wonders for his confidence and he is so much more secure now that I have had to default on a mortgage payment because of their actions. This big brother approach is denying parents the right to care properly for their children and I will not stop complaining about this, even if I end up writing to the Secretary for Education. NB: “Great” Britain, where parents are taxed for parenting!
it the same here in england. we as parents have no rights at all. the uk school system works like a dictatorship
Seems to be the status quo here in Southern New Hampshire (USA) as well.
Interesting to hear about the funding angle.
Parents are losing control.
The schools in my home district are rather unfriendly to family life in general. They often come up with ridiculous policies and procedures that seemed to be designed by someone who takes a perverse pleasure in making things as inconvenient as possible. Then, of course, everything is often (inaccurately) blamed on “State requirements). The more this goes on, the more I think the public school system should be entirely dissolved and whatever money is available for education should follow the student.
For my oldest, his school required a note for everything after 3 days of absence in a school year. It did not matter if those absences were spread apart throughout the year. We eventually decided to homeschool him. For my daughter, we never encountered this issue, but then again, she was only in public school for a few months.
My youngest son is another story. We have medical documentation stating that he is immunocompromised and his teacher fully supports me keeping him home any time I feel that he is no t healthy enough to attend. Because he is medically fragile, he has missed about 1/2 of the school year so far. Its expected…. its his first year around other children. But part of that is his teacher understands that when you put a child through 3 years of chemotherapy and then top it off with a bone marrow transplant, then when their doctor allows the to attend a school setting, that child WILL get sick more easily and will miss alot more school. The other part is that I met with the school last year regarding him, made sure they had everything they would need so I wouldn’t be rushing him off to doctors every other day. I also made it extremely clear to school administration that unless I or his doctors felt he needed to be seen, he would not be going to the doctors for minor illnesses. There is no reason for a child who has literally grown up in a doctors office to go for every sniffle or sneeze.
I am going through truancy issues myself right now, and presently am struggling with what to do in the situation. I have never, not ever, let my children skip school for unwarranted reasons. I have called in when they are sick, and followed the rules set by the school district that demand that my child not have a temperature above 100, and be fever free or vomiting/illness free for 24 hours prior to returning to school. I now am being told that I must see the superintedent of the schools because my child has had excessive absences at 9 absences (when having to keep her home for an additional 24 hour period per their instructions is VERY easy to do.) and 3 “unverified” absences where I pulled her from school 15 minutes, yes, 15 minutes, before school ended so that we could make it to a specialist appointment. My childs specialist for allergies is not open past 4:30 so in order to make it there in time, this is necessary. I am besides myself wih irritation. I now face scrutiny from the school system, when my child is an honor roll student, albeit in a lower income school district, and has never missed for ridiculous reasons. Today she is home with the stomach flu, and what do I get to do in the morning? Bring my vomiting child to the waiting room of a doctors office because I need a note. AND for them to tell me that she has the stomach flu, yadi yada, and all the information that I really don’t need to know because I have 4 children and have dealt with this a million times before. Irritated doesn’t begin to describe my feelings on this matter…. and that is all before considering the fact that I am spending 25 dollars on a copay for an appointment that is wasting the doctors time, and mine, not to mention potentially spreading some illness while my child heaves into a bucket in the waiting room.